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MARINE NOTE OF PROTEST

On this .day of .20., personally appeared and presented himself


before me . (insert name of master), Master of the (insert name of
vessel) of (insert port of registry), official no:..and ..Net Tons, which
sailed from .. on or about the . (insert date) in ballast / with cargo of
..insert brief description of cargo if any ) bound for .( insert destination
port), and arrived at port of .on (insert date) and declare that during the
voyage having experienced a collision with the ..( insert name of colliding
vessel) at about .hrs on ..(insert date of collision) in ..(insert general
location of collision, e.g in the south china sea or in the Singapore Western
working anchorage) and fearing damage to the vessels hull rigging, machinery
and / or cargo, he hereby Notes his Protest against all claim, losses, damage etc
reserving the right to extend the same at time and place convenient.
Sworn and sign before me ..Captain (insert name Master).

At . Notary Public.

Notes:
This sample is using in collision, for other accident, pls change the word collision
with actually happen. E.g: stranded, fire.

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